Clinical Practice in Pediatrics

Major hormonal and metabolic mechanisms of hypothalamic dysfunction in adolescent girls

The objective. To find hormonal and metabolic disorders in adolescent girls with hypothalamic dysfunction.

Patients and methods. We performed a retrospective cohort study comprising 170 adolescent girls aged 12 to 18 years, who were treated in the gynaecological department of the Amur Regional Children’s Clinical Hospital in the period from 2000 to 2014 with the diagnosis «Hypothalamic dysfunction (HD)». Group 1 (overweight) included 66 patients, group 2 (obesity) – 104. Body mass index (BMI) was calculated; the levels of glucose, total cholesterol (TC) and its fractions, follicle stimulating hormone (FSH), luteinizing hormone (LH), cortisol, estradiol, testosterone and progesterone were determined in venous blood serum. We also determined blood levels of insulin, tumour necrosis factor-alfa (TNF-α), interleukin-1beta (IL-1β), IL-10, and inhibin В; glycodelin was examined in menstrual blood. Data analysis was performed with the use of the programme Statistica 6.1; χ2 and Mann-Whitney statistics were calculated. Differences were considered significant at р < 0.05.

Results. The mean age of respondents was 14.41 ± 0.26 years. The average BMI values in obese girls were significantly higher – 33.36 ± 3.03 vs. 26.1 ± 1.42 kg/m2 (р = 0.000). The mean age of adiposity rebound was lower in group 2; the age of HD manifestation before menarche was 2.08 ± 1.24 years in group 1 and 4.00 ± 2.0 years in group 2 (р = 0.003). In patients of group 2, amenorrhoea was recorded significantly more often: in 27 (40.9%) cases vs. 2 (21.2%), р = 0.039. Obese adolescent girls, as distinct from overweight patients, had higher blood levels of FSH by 1.3 times, insulin and triglycerides – by 1.5 times, and the progesterone level was by 1.5 times lower. In this group, the TNF-α / IL-10 ratio was higher by 1.5 times, and menstrual blood glycodelin – by 1.8 times. Inhibin B levels in patients of group 1 was 52.06 pg/ml, and in group 2 – 47.81 pg/ml (р = 0.000). In adolescent girls from group 1, glycodelin levels in menstrual blood were by 1.8 times higher: 10.46 vs. 5.8 ng/ml (р = 0.000). Correlation analysis has shown marked significant relationships in patients of group 1 of cortisol and cytokine levels: for TNF-α r = 0.59 (р = 0.002), for IL-1β – 0.70 (р = 0.000), and for IL-10 – 0.61 (р = 0.000). In both groups, significant correlations have been found for BMI values and insulin levels (r = 0.27, р = 0.03 and r = 0.54, р = 0.000, respectively); insulin and FSH levels (r = 0.45, р = 0.000 and r = 0.23, р = 0.01); insulin and cortisol (r = 0.85, р = 0.000 and r = 0.85, р = 0.000), respectively. Inhibin В levels significantly (р = 0.000) correlated with FSH (in group 1 r = –0.83, in 2 – r = –0.57) and insulin (r = –0.84 and r = –0.76, respectively). 

Conclusion. In girls with HD, depending on body weight, there is a complex influence of disorders of the carbohydrate and lipid metabolisms and the immune system on the functioning of the pituitary–adrenal–ovarian system.

Key words: glycodelin, hormonal and metabolic disorders, adolescent girls, hypothalamic dysfunction, inhibin B, body weight, obesity, cytokines.

For citation: Zhukоvets I.V., Leshchenko O.Y., Atalyan A.V., Podoshvelev D.Р. Major hormonal and metabolic mechanisms of hypothalamic dysfunction in adolescent girls. Vopr. prakt. pediatr. (Clinical Practice in Pediatrics). 2017; 12(5): 12–17. (In Russian).
DOI: 10.20953/1817-7646-2017-5-12-17

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